Honda Kentaro, Wada Teruaki, Kunimoto Hideki, Nishimura Yoshiharu
Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8509, Japan.
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Gen Thorac Cardiovasc Surg Cases. 2025 Jan 6;4(1):1. doi: 10.1186/s44215-024-00185-z.
Patients with coronary artery disease undergoing trans-catheter aortic valve implantation (TAVI) often receive TAVI alone. However, in cases of severe coronary lesions or anticipated difficulty in coronary access post-TAVI, percutaneous coronary intervention or coronary artery bypass grafting may be necessary. We performed simultaneous gastroepiploic artery to posterior descending artery bypass and TAVI in two patients with severe calcification of the right coronary artery ostium which is unsuitable for percutaneous intervention. The procedure was conducted through an upper median laparotomy, avoiding a full sternotomy. Patients were discharged on postoperative days 6 and 9, respectively. By combining minimally invasive techniques and avoiding median sternotomy, we achieved favorable outcomes without compromising the less invasive nature of TAVI. This approach demonstrates the potential for tailored, hybrid procedures in high-risk patients with concomitant aortic valve disease and complex coronary lesions.
接受经导管主动脉瓣植入术（TAVI）的冠心病患者通常仅接受TAVI治疗。然而，在严重冠状动脉病变或预计TAVI术后冠状动脉介入困难的情况下，可能需要进行经皮冠状动脉介入治疗或冠状动脉旁路移植术。我们对两名右冠状动脉开口严重钙化且不适合经皮介入治疗的患者同时进行了胃网膜动脉至后降支动脉旁路移植术和TAVI。手术通过上腹部正中切口进行，避免了正中胸骨切开术。两名患者分别于术后第6天和第9天出院。通过结合微创技术并避免正中胸骨切开术，我们在不影响TAVI微创特性的情况下取得了良好的效果。这种方法显示了在伴有主动脉瓣疾病和复杂冠状动脉病变的高危患者中进行定制化杂交手术的潜力。
